A new perspective paper published in The American Journal of Clinical Nutrition calls for a ‘paradigm shift’ in how public health agencies address hypertension. The condition affects more than 1.28 billion adults worldwide and is a major cause of cardiovascular disease. Researchers say blood pressure may be managed more effectively by combining lower sodium intake with increased consumption of potassium-rich foods.
The World Health Organization (WHO) recommends that adults consume less than 2,000 milligrams of sodium per day and more than 3,500 milligrams of potassium daily.
However, average global sodium intake is approximately twice the recommended limit, while potassium consumption remains below target levels in many countries.
In high-income nations, most dietary sodium comes not from salt added during cooking or at the table, but from foods purchased outside the home. Packaged products, processed foods and restaurant meals are major sources of excess sodium.
In the new paper, University of Vermont Professor Naomi Fukagawa and her colleagues argue that relying on sodium reduction alone has been difficult to sustain at the population level. Challenges include consumer preference for salty flavors and the technical difficulties food manufacturers face when reformulating products.
At the same time, evidence supporting potassium’s independent role in blood pressure control continues to grow.
“Hypertension affects over 1.28 billion adults worldwide and is a leading risk factor for cardiovascular disease,” the researchers said.
“Excessive sodium intake and insufficient potassium consumption are major modifiable contributors to elevated blood pressure, leading the WHO to recommend sodium intake below 2,000 mg/d and potassium intake above 3,500 mg/d.”
“Importantly, hypertension is the driver of cardiovascular disease risk and not merely a marker of excess sodium intake.”
“Despite the current dietary guidelines, average sodium intake remains significantly above recommendations, whereas potassium intake is often far below optimal levels in both developed and developing nations.”
“Historically, sodium reduction has been the targeted strategy for public health interventions to reduce population blood pressure.”
“Food manufacturers have been using potassium chloride and other potassium-containing ingredients as a tool to reduce sodium over the years, but new understanding of potassium’s critical role and efficacy in reducing blood pressure calls for a paradigm shift to consider sodium and potassium together when developing recommendations.”
The researchers highlight a biological mechanism called the renal potassium switch, which helps the kidneys regulate sodium and potassium during urine production.
This system evolved when potassium was scarce and helped the body conserve the mineral. However, it may work against modern diets that contain too much sodium and too little potassium, potentially contributing to elevated blood pressure.
Clinical research also supports a combined sodium-and-potassium approach. The China Salt Substitute and Stroke Study found that replacing some sodium chloride with a potassium-based salt substitute lowered blood pressure and reduced cardiovascular events.
Modeling based on that study and related research suggests that a substantial portion of the health benefit may have resulted from increased potassium intake, in addition to the reduction in sodium.
The authors recommend several strategies to improve hypertension prevention and management. These include exploring sodium-to-potassium ratios as a target for food reformulation, expanding public education about potassium-rich foods such as fruits and vegetables, and introducing policies that improve access to these foods for lower-income households.
Potassium-enriched salt substitutes could also provide a practical short-term option for reducing sodium intake. However, the researchers caution that these products may not be suitable for people with advanced kidney disease or those taking certain medications. Individuals should seek medical advice before using potassium-based salt substitutes.
The authors acknowledge that definitive potassium guidelines remain difficult to establish. A 2019 report from the National Academies of Sciences, Engineering, and Medicine concluded that available dose-response data were insufficient to set formal potassium targets for reducing chronic disease risk. Nevertheless, the researchers argue that waiting for perfect evidence could delay important public health action.
They conclude that reducing dietary sodium remains a fundamental strategy for preventing and managing hypertension.
However, growing evidence supports broadening the current approach, which has traditionally focused primarily on sodium reduction, to place equal emphasis on increasing potassium intake.
“It is time to view dietary interventions holistically because food components interact and physiology is integrative across systems,” Professor Fukagawa said.
“Growing evidence shows that increasing dietary potassium as well as reducing sodium intake work together to better manage hypertension.”
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Naomi K. Fukagawa et al. 2026. Rethinking the impact of dietary sodium and potassium on blood pressure to advance public health. The American Journal of Clinical Nutrition 124 (2): 101396; doi: 10.1016/j.ajcnut.2026.101396
Source: www.sci.news